Guide My Work With Borderline Patients

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Written informed consent was provided by all patients with BPD. Participating patients with BPD represented a heterogeneous group with respect to employment, varying from recent or long-term employment or unemployment to having multiple jobs in their employment history, see Table 1. The type of employment was also diverse S1 Table. Participating professionals differed in age, years of experience in working with patients with BPD, discipline in the MHP group , and sex primarily in the IP group , see Table 2. Several themes emerged from the data as barriers and facilitators to employment.

The overarching themes were classified into: characteristics of BPD, stigma and support to employment. Most barriers and facilitators were interchangeably connected as the identified barriers and facilitators related to similar features, see Table 3. No participants were currently enrolled in a vocational rehabilitation program, however few participants had previously received general vocational rehabilitation services.

Nonetheless, no participant had experience with IPS. Support to employment in the following text refers to all previous vocational rehabilitation services provided to patients in this study. All patients related their problems with gaining and maintaining employment primarily to symptoms of BPD. How patients coped with their symptoms in relation to employment varied widely. Patients with BPD noted having high expectations of themselves while simultaneously failing these expectations and ruminating about how others might perceive them.

Also, rapid mood swings caused problems to comply with previously made appointments, mostly due to instantly and unpredictably feeling depressed or behaving impulsively. I am continuously crossing them myself and find it hard to communicate them to others at my work. I just continue working. Most patients mentioned having problems in several domains of life such as social, financial and their living situation. Also, comorbidity with other mental disorders such as affective and substance use disorders was frequent. I could not understand how I could lose them.

Often they pose them too late or too little. A lack of assertiveness or interpersonal skills really. This contrasts with the descriptions provided by patients and MHPs, they stated that mood swings and impulsive behavior were caused by low self-image. Furthermore, black and white thinking and externalization impeded gaining and maintaining employment according to MHPs and IPs. This is because externalization caused difficulty in evaluating previous conflictual situations and mitigated self-awareness in individuals with BPD.

However , when it comes down to it they perform poorly which tends to irritate employers. Realizing a goal is possible , but very often not together with colleagues , which makes it hard. For example, patients with BPD often wanted to work with vulnerable people. Eventually, this compassion for others often turned into a barrier due to a lack of posing personal boundaries and becoming overly involved until they call in sick or act impulsively. The following characteristics in patients with BPD were described as facilitators to employment: working hard, being entrepreneurial, ambitious and passionate, and having various interests.

MHPs described that patients with BPD, despite the association with dysfunctional interpersonal skills, are emphatic and sensitive to others. However, all groups came to realize that these facilitating characteristics could easily change into barriers. Somehow , I take it all too seriously , I want to do well and I run the risk of losing myself in my work. Patients described how treatment helped them to better understand their feelings by learning to regulate their emotions.

I observed my own behavior and came to realize that I should stop pointing my finger at other people. My psychologist taught me to stop being a victim [.. MHPs emphasized that treatment is furthermore needed to increase self-image and self-awareness and improve sensing and posing personal boundaries. Treatment also contributed to diminish the stress experienced from problems in various life domains by helping to increase overview and structure. According to all participants diminishing impeding BPD characteristics was necessary before return to employment, however IPs were unfamiliar with treatment prospects in BPD.

Some patients with BPD gave examples of being fired due to involuntary disclosure of their diagnosis. However, two participants had good experiences with disclosure. All, except these two participants, would not disclose their diagnosis in the future because they believed BPD is being stigmatized. They felt that disclosure would abate their chances to gain employment, or expressed not to know how to disclose their diagnosis in a constructive manner. Simultaneously, during the focus group MHPs realized they were stigmatizing themselves and tended to think that patients with BPD would not recover from their disorder.

Moreover, both professional groups would not recommend disclosing BPD to potential employers. They just wait and see how you respond. MHPs acknowledged there was little attention for employment in most treatment programs. There was however, one treatment program that devoted sessions to post-treatment employment. IPs acknowledged having a lack of knowledge in treatment prospects for BPD. Also, IPs noted that collaboration between mental health and vocational rehabilitation services was lacking. One IP however from another region , stated that their office had a fruitful collaboration with mental health institutions marked by frequent counselling and educating each other.

IPs addressed that it was difficult to assess working capability for someone with BPD because based on the criteria of disability insurance, patients with BPD are mainly assessed as eligible for certain types of employment. However, IPs simultaneously realized that in order to increase sustainable employment it might be necessary to reduce BPD symptoms first. All participants acknowledged the importance of employment. Furthermore, all patients with BPD wanted to be employed and expressed hope in achieving this goal, although two patients realized return to competitive employment was no longer feasible for them one was found to be incapacitated for work according to the Work Capacity Act WAO.

Furthermore, patients with BPD described that they often felt misunderstood outside the mental health care system. Therefore, they would rather start exploring ways to re- start employment during the course of their treatment. Furthermore, this exploration preferably took place with one designated person to discuss potential difficulties and support in gaining and maintaining employment and to whom they could potentially return. All groups expressed that collaboration between mental health services and vocational rehabilitation should be improved to enhance support to employment in patients with BPD.

Most patients described that in previous working experiences a working environment in which they felt comfortable and accepted was the most important aspect. Some patients described how work distracted them from symptoms of BPD such as mood swings and negative thoughts. Both MHPs and IPs described a similar working climate necessary, in which a certain amount of freedom with clearly defined tasks was key. In the present study, barriers and facilitators to employment in BPD were studied by interviewing patients, mental health practitioners, and insurance physicians.

We found that the identified barriers and facilitators related to three overall themes: characteristics of BPD, stigma and support to employment. Generally barriers and facilitators corresponded to identical features, revealing an interactive process within each theme.

The suggested facilitators provided key elements of targeting the identified barriers. Overall, more barriers than facilitators were mentioned by all groups, especially when BPD symptoms were not treated. Also identified barriers were mostly related to maintaining employment and less to gaining employment, which seems different than for other severe mental disorders.

According to all participants barriers mainly related to symptoms of BPD. This finding is consistent with literature proposing a link between the core symptoms of BPD mood swings and problems in interpersonal relationships and self-image and multiple areas of impaired functioning [ 1 , 6 , 47 ]. Although patients with BPD stated to have the ability and wish to work with others, they simultaneously felt misunderstood and reported low self-image and difficulties in posing personal boundaries.

This corresponds to previous findings showing that although patients with BPD accurately sensed and connected to the emotions of others, their understanding and contextualizing of emotions and thoughts of others was impaired compared to healthy controls [ 48 , 49 ]. Furthermore, patients with BPD explained how multiple problems from different domains of life further aggravated their sense of loss of overview, also affecting their job. Previous studies showing a chronic state of heightened affect in patients with BPD [ 50 ] could explain this vicious circle of additional problems typical in BPD.

We additionally noted that, in contrast to other severe mental disorders, where a lack of motivation or work experience mainly hindered gaining employment [ 24 , 32 ], BPD patients in our study experienced difficulty in maintaining employment and adequately regulating emotions at work. The participants in the present study explained that treatment is needed to diminish symptoms and thereby increase functioning. In turn, being employed was found to naturally diminish BPD symptoms [ 7 ] and increase self-reflection [ 13 ]. Due to a difficulty in regulating emotions, patients with BPD were often overwhelmed by their emotions and consequently had lessened understanding of their behavior resulting from these emotions.

This low self-awareness, self-reflection, and self-directedness in BPD were previously described as being the cause of externalization and overestimation in BPD [ 51 , 52 ]. Furthermore, patients with BPD are more likely to report on problems as caused by others [ 36 ]. Acknowledging externalization and simultaneously challenging thoughts and feelings of rejection can be used to find ways for patient and practitioner to break out of a vicious cycle of detrimental interplay.

However, this did not always lead to successful placements. Previous studies showed that negative attitudes of professionals towards the capacity to gain employment impeded gaining and maintaining employment in patients with mental illnesses [ 55 , 56 ]. This may also hold for patients with BPD. Furthermore, Bungert and colleagues [ 57 ] previously suggested that the negative attitudes of professionals could increase feelings of rejection and abandonment in patients with BPD. Simultaneously, both MHPs and IPs realized being at risk of inducing anticipated stigma in patients with BPD by having little hope for improvement in functioning.

This anticipated stigma from professionals was previously argued to impede gaining employment [ 45 ]. Simultaneously, disclosure could serve as a means to communicate needs and adjust working conditions accordingly, ultimately increasing sustainable employment and targeting stigma [ 58 — 60 ]. Among patients however, fear of stigma and discrimination was an important reason for non-disclosure. This was confirmed by the patients from the present that already received treatment for some time. Furthermore, professionals explained that an increase of self-reflection through treatment was needed to increase sustainable employment.

In addition to previous studies on barriers and facilitators to employment in mental health disorders, the present study suggested useful strategies for practice, such as developing a manual to manage disclosure and promoting the positive features of BPD in the public domain to target stigma. An important facilitator identified in our study was that most patients with BPD wanted to be employed in the future and expressed hope of achieving this goal. This is essential since the motivation to be employed is found to be a predictor of sustainable employment in individuals with mental illness next to job match, support and self-confidence [ 32 , 62 ].

IPs acknowledged the importance of motivation for employment, yet generally perceived the desired job of patients with BPD as unsuitable. However, matching job wishes and following patient preferences are key elements of supported employment and important facilitators for sustainable employment [ 32 , 62 , 63 ].

The need to increase collaboration between mental health and vocational rehabilitation services was endorsed by all participants. Patients with BPD found support to employment strategies fragmented and not fitting their needs. Previous studies addressed this lack of support and insufficient collaboration between mental health services and SSA in individuals with diverse mental health problems [ 25 — 27 , 64 ].

Treating borderline personality disorder

In line with our findings, these studies showed that a lack of collaboration between services together with having problems in different domains of life, next to mental health problems, affected return to employment. They stated that more support is needed in addressing these problems in order to sustainably return to work. In addition to this literature the present study demonstrates that the sometimes diverging perspectives of patients and professionals requires a better understanding of BPD to better match adequate support. Integrating vocational rehabilitation services within mental health care following patient preferences and providing long-term support are key principles of the evidence-based supported employment method IPS [ 65 ].

Given the identified barriers in this study, IPS thus seems to be a particularly suitable method of supported employment in BPD. Currently in the Netherlands however, although all individuals regardless of type of mental disorder are eligible for vocational rehabilitation, IPS is only available for patients in FACT care.

Importantly, IPS has recently also been shown to be effective in other populations than in patients with severe mental illness, such as patients with post-traumatic stress disorder, common mental disorders and substance use disorders [ 69 ]. Bond and colleagues suggest that modifications in the IPS program might be needed in these patient groups as they are often heterogeneous and in need of an individualized approach, which is in line with the pragmatic principles of IPS not being specific to any impairment or condition. This may also hold for IPS in patients with BPD as they often have heterogeneous symptoms, significant comorbidity and outspoken wishes for employment, which are, according to professionals, not always easy to match.

To the best of our knowledge this is the first study qualitatively examining barriers and facilitators to employment in BPD among patients, MHPs and IPs. Strengths of the current study include: 1 the triangulation of perspectives from patients, MHPs and IPs as assessed with both in-depth individual interviews and focus group interviews, 2 the comparison between different perspectives from two fields of practice, and 3 the broad sample of patients with BPD constituting those with diverse backgrounds in age, work history and treatment history.

The study, however, also has limitations. First, snowballing was used to include eligible participants, which might have led to selection bias. Second, it is conceivable that patients with a less favorable attitude towards employment were not interested in participating, leading to an overestimation of the perceived importance of employment in BPD especially since we had little information about non-responders. Third, patients from the present study represent a selective group of BPD patients that are in specialized treatment programs for BPD.

A significant portion of BPD patients are not in treatment [ 6 , 70 ]. Clearly, our results do not generalize to all individuals with BPD. Fourth, we did not study the interplay between patients and both professionals groups, which would have extended our findings. However, from this first explorative study we found that perspectives diverged.

Therefore, future research could study the interplay between patient and professional dyads in a multiple case study design. Fifth, the perspectives of employers were not explored which causes the results to be relatively less applicable to the pathway of maintaining employment. Sixth and finally, most patients with BPD in the present study also had other mental disorders, that by themselves have been shown to impair employment. Likewise, comorbidity of BPD with affective disorders was found to increase occupational impairment [ 18 ]. Although during the interviews we consistently aimed to distinguish the barriers and facilitators originating from BPD from those originating from possible comorbid disorders, we cannot completely disentangle them in this study.

References

In addition, severity of BPD has been argued to be a determinant of impairment in occupational functioning [ 71 , 72 ]. The identified barriers and facilitators guide future research into employment in BPD and suggest that support to employment in individuals with BPD can be enhanced. The present findings clearly suggest that diminishing symptoms, examining stigma and increasing support to employment could serve as starting points for future research. Most identified facilitators correspond to important elements of evidence-based support programs to employment, such as IPS.

These programs have a patient-centered approach and integrate mental health and vocational services [ 63 ]. Studying the effectiveness of IPS, which so far has been primarily examined in the context of severe mental illness in general [ 73 — 76 ], may be a promising first step. In studying support to employment for BPD, key elements should be 1 acknowledging a potential divergent perspective in professionals and patients about suitability of pursued employment, and 2 examining the role of stigma and disclosure in the pathway of gaining and maintaining employment for patients with BPD.

Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Background Borderline personality disorder BPD is associated with unemployment and impaired functioning. Results All participants described barriers and facilitators relating to three overall themes: characteristics of BPD, stigma, and support to employment.

Conclusions The present findings revealed that both facilitators and barriers are important in gaining and maintaining employment in BPD in which diminishing symptoms, examining stigma and increasing support to employment are key. Funding: The authors received no specific funding for this work. Introduction Borderline personality disorder BPD is a severe mental disorder characterized by an enduring and pervasive pattern of instability of interpersonal relationships, self-image and affects, marked by impulsivity and para suicidal behaviors [ 1 ].

Methods Design A qualitative explorative study using semi-structured interviews in patients and focus groups in MHPs and IPs was performed to collect rich and in-depth data on barriers and facilitators to employment in BPD. Context In the Netherlands mental health and vocational rehabilitation are separate services. Sample and data collection procedures Patients with BPD. Mental health care professionals and insurance physicians. Ethical considerations. Results Participating patients with BPD represented a heterogeneous group with respect to employment, varying from recent or long-term employment or unemployment to having multiple jobs in their employment history, see Table 1.

Download: PPT. Table 1. Socio-demographic and clinical characteristics of patients with BPD. Table 2. Characteristics of mental health practitioners and insurance physicians. Table 3. Barriers according to mental health practitioners and insurance physicians. Proposed facilitating characteristics in relation to barriers according to all participants.

Stigma Barriers according to patients with BPD. Proposed facilitators to target stigma according to all participants. Support to employment Barriers in support to employment according to patients with BPD. Barriers in support to employment according to mental health practitioners and insurance physicians. Proposed facilitators necessary to improve support to employment in BPD according to all participants.

Discussion In the present study, barriers and facilitators to employment in BPD were studied by interviewing patients, mental health practitioners, and insurance physicians. Support to employment An important facilitator identified in our study was that most patients with BPD wanted to be employed in the future and expressed hope of achieving this goal. Strengths and limitations To the best of our knowledge this is the first study qualitatively examining barriers and facilitators to employment in BPD among patients, MHPs and IPs.

Conclusions and implications for practice and further research The identified barriers and facilitators guide future research into employment in BPD and suggest that support to employment in individuals with BPD can be enhanced. Supporting information. S1 File. Topic list. S1 Table. Characteristics of patients with BPD. Acknowledgments We thank all the patients and professionals who participated in the interviews and focus groups.

References 1. American Psychiatric Association. Prevalence and correlates of personality disorders in a community sample. Br J Psychiatry. Prevalence and correlates of personality disorder in Great Britain. Biol Psychiatry. Paris J. Estimating the Prevalence of Personality Disorders in the Community. J Pers Disord. Leichsenring F.

Borderline Personality Disorder. Elsevier Ltd; ; 74— Personal Disord Theory, Res Treat. Jovev M, Jackson HJ. The relationship of borderline personality disorder, life events and functioning in an Australian psychiatric sample. Functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder.

Am J Psychiatry. Occupational functioning and work impairment in association with personality disorder trait-scores. Soc Psychiatry Psychiatr Epidemiol. Vocational functioning in schizotypal and paranoid personality disorders. Psychiatry Res. Elsevier; ; — Sustained unemployment in psychiatric outpatients with bipolar depression compared to major depressive disorder with comorbid borderline personality disorder. I just wanted to express rage.

I always felt that the people who were treating me were disgusted by me. Mental health professionals go into the field because they want to help people. When a client doesn't get better despite the therapist's best efforts, it's tempting to blame the client for the lack of progress and to view their attempts at trying to get what they need as manipulation, rather than to question whether the treatment they're providing is effective. Of course, all of this is only a problem if your family member is willing to walk through a clinician's door. Before you start the search, make a realistic assessment of whether your loved one is willing or ready to enter therapy.

If not, therapy may be an expensive waste of time. Nearly everyone in the WTO community has made numerous attempts to compel their family member to see a therapist. Common methods include. For good measure, the BP also accuses the non-BP of being abusive, unreasonable, and controlling.

Stage 2: In desperation, often during a crisis, the non-BP finally resorts to an ultimatum such as, "Go to a therapist or I'm leaving you," or some other consequence. The non-BP hopes that once the BP is in therapy, the clinician will force their family member to see the light. If you are serious about limiting or leaving the relationship and and your family member knows this is true, this is the only thing I have seen really work to pursuade the disordered person to seek help.

Stage 3: Apprehensive that their loved one might actually carry out their threat, the BP agrees to see a therapist, perhaps with the partner or other family members. Therapy, however, goes nowhere. That's because even the best BPD clinicians can't help a patient who doesn't want to be helped. Stage 4: Once the immediate threat dissipates, the BP finds some reason to drop out of therapy. This is especially true if the therapist is a good one, skilled at bringing the focus to the BP's core issues instead of reinforcing the BP's feelings of victimhood.

However, if the therapist takes everything the BP says at face value without probing further—and this is not uncommon—the therapist may inadvertently reinforce the BP's twisted thinking, making things worse. Stage 5 : Eventually, the non-BP realizes that forced therapy is not going to work and that no one can "make" anyone do anything a good life lesson, by the way. Sometimes the whole process needs to be repeated several times before this truism becomes evident. Stage 6: Months or years later, the non-BP realizes that her efforts to change the other person simply added a thick second layer of conflict on top of the original issues.

She becomes even more disillusioned, depressed, angry, and hopeless. As one Welcome To Oz member noted, "My attempt to invade his world with facts only caused more pain. Therapy is hard work. Transforming the way you think, feel, and act while taking responsibility for things you've always blamed on someone else is a tall order. People with BPD who are serious about treatment will pursue it, perhaps with your help, and make a commitment to it.

They will make their own appointments, be honest with their therapist, and complete any "homework" the therapists give them. Life coach A. Mahari says, "The truth is relative, and each person with BPD must come to their own truth in their own time and way. That said, for the sake of readability, in this chapter the term "you" as in, "When you call the therapist, leave a voice mail could mean either the family member parents, especially or the individual with the disorder.

Some BPs will only concede that they need help after they have hit rock bottom—after someone they love does end the relationship or they wind up in jail or under psychiatric observation. I believe that there needs to be some kind of major upheaval that serves as a catalyst for a borderline to face the truth. Not wanting to lose something, perhaps. They can no longer blame the power-hungry boss or the bitchy spouse or the scores of people who have it in for them. But denial is a funny thing.

What some of us may see as shocks or the bottom isn't necessarily going to be viewed that way by the BP. So they've destroyed a relationship? They move on to the next one, and so on. They get fired from a job they liked? Blame it on the boss and get another one. Lose custody of the children? It's the damned court system. The fear of change, the compelling fear of the unknown, is so intrinsic, so vast, so encompassing and overwhelming, that it's greater than the tragic events that would send most people down to their knees.

The shock cannot be predicted, nor contrived. It can't be provoked by the greatest of efforts or good intentions on the part of another. Mahari advises family members to let go of any desire to control what's going on in therapy. The less you're involved, the better able they will be to take care of themselves and observe their limits. Be positive, but beware that making too much progress can be threatening to your family member. If they enter recovery, the thinking goes, they might lose your intensive support.

Plus, if they relapse, you might be disappointed in them. So be encouraging and optimistic, by all means, but be sensitive to this as well. The speed limit changes and there's a few stop signs, too. Mahari says, "There are no simple rules here. This is not the rehabilitation of a physical injury.

This is the rehabilitation of the entire self.

The Use of Benign Authority with Severe Borderline Patients: A Psychoanalytic Paradigm

Whether you're a BP or a non-BP, going into full-throttle search mode for a therapist can help overcome feelings of hopelessness and helplessness. There are some things that you can't do. But searching for a therapist is one thing you can do. Learn everything you can about BPD from recent and reputable resources. You'll come across contradictory information, especially in the area of causes and treatment. So the more research you do, the firmer your foundation will be and the better you'll have a handle on which therapist can best meet your needs.

Let a potential therapist know you've done research and the descriptions of BPD symptoms seem to match your family member's symptoms. Document your own or your family member's struggle with the disorder. Write a short medical history that includes the following:. List all medications currently being taken, their dosages, what time of day they're taken, and what they're for. It will come in handy when you fill out forms. Explain why, such as it wasn't effective or produced undesirable side effects. This will help during the trial and error process. Perhaps a different dosage may produce better results or fewer side effects.

You might also talk about the impact the BP's behavior has had on family members. Having this information at your fingertips will be useful in many ways. For example, it will help with continuity of care and remind you of questions you want to ask. Once therapy begins, this record will help the clinician obtain the most information in the shortest amount of time.

Many people find it a validating and healing exercise to see it all laid out in one place. Feel good about yourself; you've made it this far! Get up close and personal with your health insurance documentation. Call the company if you don't understand the plan. Pay special attention to what they pay for and what you must pay for. Assess your finances to determine whether you can pay for co-payments and services that aren't covered. Once you do settle on a therapist or treatment program, talk about fees right away. Bring up matters such as co-payments and how you're supposed to pay them. Some want payment at each session.

Find out whether the provider offers a discount for private-pay patients. Some providers will offer discounts for payment with cash or check because health insurance has so much red tape. Ask about a monthly payment plan. If you are a parent looking for help for your child of any age, mentally prepare yourself for running into at least one clinician who assumes you caused your child's disorder.

Some may be explicit about this; others just imply it or treat you in a disapproving way. This is one reason why it's so important for you to do your own research, especially on the chemical and genetic risk factors of developing BPD. The father of a borderline child who is a member of an online support group for parents says:. Despite all the new information about what causes BPD, we parents still come across clinicians who automatically assume that we've mistreated, abused, neglected, or invalidated our children. This is harder to endure than my daughter's outbursts and even her punching and kicking.

It's like screaming for a lifeguard when I see my daughter drowning, then running out to save her, and when the lifeguard gets there he punches me in the gut for deliberately trying to drown my own daughter. And the tragedy is, while he's hitting me, she's still sinking, crying for help. If you are accused, pretend you have a rubber shield around you so the hurtful words bounce right off you. Do not take them personally. They are no reflection on you, and the next parent who walks through the door will probably get the same treatment. Here's another way that looking for a good therapist is like searching for a job: networking produces some of the best leads.

You don't have much to lose if you also ask her whom she would not recommend. They can contain a great deal of information about the therapist—orientation, interests, philosophy, background—and it's easy to hone in on the ones who most interest you. You may want to begin your search process by looking at these to see the type of information the therapists give.

The grapevine is long and thick, and they may have a good buddy in a relevant department. If you know a psychiatric nurse or aide, you've hit pay dirt. A therapist who treats depression is easier to locate and may know of a peer who works with borderline clients who have that co-occurring disorder. Some local mental health services are listed in the phone book in the blue government pages.

In that section, look for listings under "Mental Health. Top clinics like to become associated with top people. These psychiatrists are often on the cutting edge of research. Also, ask for recommendations of people trained in that university's psychiatry or psychology program. Mental health professionals are listed under "counseling," "psychologists," "social workers," "psychotherapists," "social and human services," and "mental health. Look into low-cost or sliding fee clinics. Before you contact your candidates, search for them on the Internet. These days, many clinics and practitioners have Web sites that can give you insight into their treatment methods, interests, and philosophy.

Remind yourself that if you were getting your house painted, you would ask for references and check them out. And your loved one's mental health is a lot more important than the color of your house! Call or email the offices of the best candidates. Introduce yourself and explain the reason for the call. Leave a voicemail and suggest good times to call you back. Once you connect, ask if they have time to chat with you on the phone for a few minutes. The way the therapist answers the questions is also revealing. A good one should encourage you to shop around for the right therapist and not be offended that you're asking questions.

Consider whether you want to use the actual term borderline personality disorder, especially if your loved one hasn't been formally diagnosed. If you do, the image of suicidal, self-harming, lower-functioning conventional BP will most likely come to the clinician's mind. If that doesn't describe your family member, be cautious about using it. Even if you do have a lower-functioning conventional BP family member, you may wish to just describe the traits themselves first to help the therapist keep an open mind.

Medical professionals can sometimes loom larger than life. Remember, you're paying them, and, depending upon your circumstances, that could run into the thousands of dollars. Don't be intimidated by their degrees or the cost of their office furniture. Be open-minded, but trust your instincts. Few people ever say, "I wish I hadn't trusted my instincts. You'll be evaluating prospective clinicians in three areas: hard factors, soft factors, and attitudes and beliefs about BPD. Some therapists work closely with particular populations, such as Christians, gay men, or ethnic minorities.

For lower-functioning conventional BPs, this is critical. Who covers for you when you're unavailable? The clinician's credentials should be from a nationally recognized, respected organization or an accredited school of higher learning. This assures you that the clinician has met at least minimal standards in his education and abilities. Call—or check online—the state licensing board to make sure there's no history of legal or ethical complaints.

Some clinicians have not been specifically trained; they just prefer working with younger patients. There are fewer therapists who specialize in working with children, so you may have to look harder.

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How to choose a BPD therapist - BPD Central

You will probably feel comfortable asking some of these questions over the phone. Getting answers to a few of the following requires at least one visit to the office. Or, the answers may reveal themselves over time. If you're evaluating a clinician who practices within a standardized therapy program, you may find the answers to most of these questions in the program materials. This is a significant factor that prospective clients often overlook.